This application is submitted in response to NIH Challenge Area (05): Comparative Effectiveness Research, specifically Challenge Topic 05-DE-102: Treatment of Tobacco and Drug Dependency in Dental Settings. The proposed project seeks to tailor existing Screening, Brief Intervention, Referral and Treatment (SBIRT) protocols for alcohol abuse to be used in dental practice settings. SBIRT protocols have demonstrated effectiveness in reducing alcohol use and related problems and in motivating treatment utilization in a number of health care settings. Given their effectiveness and low cost, and the fact that both ADA and ADHA promote preventive initiatives for oral cancer screening and tobacco cessation, the absence of parallel protocols for alcohol abuse in dental practice is a concern. Given that a minimum of 60% of the U.S. population visits a dental practitioner at least once per year, the implementation of SBIRTs in dental practice settings could have enormous public health significance. In response to this Challenge, we propose a multi- level approach to understand and predict facilitators and barriers to the adoption, implementation fidelity, and effectiveness of alcohol SBIRT in dental practice. Based upon individual-level (e.g., Trans-theoretical Model) and organizational (Resource Dependency and Institutional) theories, we propose that adoption, implementation fidelity, and effectiveness of SBIRT will be impacted by factors at the practitioner level and practice level. This application seeks Challenge funding to extend our research by inviting 30 dental practices in the Hampton Roads area of Virginia who participated in our previous study to take part in a study of SBIRT adoption, implementation fidelity, and effectiveness. Dental practices agreeing to adopt SBIRT will be randomized to either SBIRT or control (assessment only). Approximately 400 patients meeting screening criteria for alcohol abuse will receive baseline, 3-, and 6-month assessments to evaluate SBIRT effectiveness. Hierarchical Linear Modeling (HLM) techniques will be applied to data on practitioner and practice-level variables in combination with data from the randomized trial to address the following Specific Aims: Aim 1: Identify practitioner and practice-level factors associated with agreement to adopt SBIRT. Aim 2: Evaluate the effectiveness of SBIRT protocols (compared to assessment-only controls using a randomized controlled design) to assess the reduction of alcohol use (quantity, frequency measures and frequency of binge drinking) and alcohol-related problems from baseline to 3- and 6-month follow-up intervals. Aim 3: Identify practitioner and practice-level factors associated with fidelity of SBIRT implementation (using data from audio-taped hygienist interventions coded for fidelity to motivational interviewing principles). Aim 4: Examine both direct and indirect effects of practitioner and practice-level factors on the effectiveness of SBIRT protocols with regard to reducing alcohol use and related problems, specifically considering the possible mediating role of implementation fidelity. We hypothesize that patients in the SBIRT condition will have greater reductions in alcohol use and alcohol-related problems at both follow-up periods (Aim 2). From a multi-level perspective, it is hypothesized that practitioner level (more recent training, more preventive orientation, greater professional familiarity with clinical practice guidelines and professional association initiatives) and practice level (larger practices with greater resources, involvement in other preventive initiatives) variables will be positively associated with SBIRT adoption (Aim 1), implementation fidelity (Aim 3), and effectiveness (Aim 4). The overall objective of the proposed Challenge Grant in response to 05-DE-102 is both to demonstrate the effectiveness of dental practice based SBIRT as well as to identify contextual factors influencing delivery and effectiveness. Ultimately, this will lead to a larger randomized trial to assess the effectiveness of SBIRT for improving the health, social, and economic functioning of the population. Given estimates of the prevalence of alcohol abuse in the United States as high as 10 million people, dental practice based SBIRT has great potential to improve the nation's health. Alcohol abuse is estimated to impact 10 million Americans with great personal, familial, and social costs. Screening, Brief Intervention, Referral and Treatment (SBIRT) approaches been effective in both reducing alcohol use and related problems in other health care settings, but have not been tested in dental practice. As a minimum of 60% of the U.S. population visits a dental office each year, the present project to test the effectiveness of SBIRT in dentist's offices can have enormous public health significance.